COMMUNITY MEMORIAL HOSPITAL INC: Form 990, tax year 2017
View the entire original 990 at ProPublica ↗
- Organization
- COMMUNITY MEMORIAL HOSPITAL INC (EIN 46-0219795)
- Tax period
- 2017-01-01 to 2017-12-31
- Filed
- 2018-10-09
- IRS object ID
- 201842829349300519
- Schema version
- 2017v2.3
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990
- Schedule A
- Schedule B
- Schedule D
- Schedule G
- Schedule H
- Schedule L
- Schedule M
- Schedule O
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2018-10-09T15:07:55-05:00 | ReturnTs |
| Tax Period End | 2017-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 450250958 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EIDE BAILLY LLP | BusinessNameLine1Txt |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 200 EAST 10TH ST PO BOX 5125 | AddressLine1Txt |
| City | SIOUX FALLS | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 571175125 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnTypeCd |
| Tax Period Begin | 2017-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 460219795 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | COMM | BusinessNameControlTxt |
| Phone | 6057752621 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 319 | AddressLine1Txt |
| City | BURKE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 575230319 | ZIPCd |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | MISTIE SACHTJEN | PersonNm |
| Person Title | CEO | PersonTitleTxt |
| Phone | 6057752621 | PhoneNum |
| Signature | 2018-09-26 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | LAURIE HANSON | PreparerPersonNm |
| PTIN | P00851848 | PTIN |
| Phone | 6053391999 | PhoneNum |
| Preparation | 2018-09-26 | PreparationDt |
Filing Security Information FilingSecurityInformation
IP Address IPAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| I Pv4 Address | 8.39.233.43 | IPv4AddressTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| IP | 2018-09-26 | IPDt |
| IP Tm | 13:14:40 | IPTm |
| IP Timezone | CD | IPTimezoneCd |
| Filing License Type | P | FilingLicenseTypeCd |
| At Submission Creation Device Id | C60744DF19E5C03A9C437C749616A21E1534802F | AtSubmissionCreationDeviceId |
| At Submission Filing Device Id | A01853E6EF032EEC7D4C024333A5FA8796B776CD | AtSubmissionFilingDeviceId |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2017 | TaxYr |
| Build TS | 2018-06-14 16:35:46Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Principal Officer | MISTIE SACHTJEN | PrincipalOfficerNm |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 319 | AddressLine1Txt |
| City | BURKE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 575230319 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Gross Receipts | $5,329,925 | GrossReceiptsAmt |
| Group Return For Affiliates | 0 | GroupReturnForAffiliatesInd |
| Organization501c3 | Yes (X) | Organization501c3Ind |
| Website Address | WWW.BURKEHOSPITAL.COM | WebsiteAddressTxt |
| Type Of Organization Corp | Yes (X) | TypeOfOrganizationCorpInd |
| Formation | 1945 | FormationYr |
| Legal Domicile State | SD | LegalDomicileStateCd |
| Activity Or Mission | PROVIDE MEDICAL SERVICES | ActivityOrMissionDesc |
| Voting Members Governing Body | 9 | VotingMembersGoverningBodyCnt |
| Voting Members Independent | 4 | VotingMembersIndependentCnt |
| Total Employee | 65 | TotalEmployeeCnt |
| Total Volunteers | 10 | TotalVolunteersCnt |
| Total Gross UBI | $0 | TotalGrossUBIAmt |
| Net Unrelated Bus Txbl Incm | $0 | NetUnrelatedBusTxblIncmAmt |
| PY Contributions Grants | $903,999 | PYContributionsGrantsAmt |
| CY Contributions Grants | $401,381 | CYContributionsGrantsAmt |
| PY Program Service Revenue | $4,677,016 | PYProgramServiceRevenueAmt |
| CY Program Service Revenue | $4,739,594 | CYProgramServiceRevenueAmt |
| PY Investment Income | $32,559 | PYInvestmentIncomeAmt |
| CY Investment Income | $61,544 | CYInvestmentIncomeAmt |
| PY Other Revenue | $58,426 | PYOtherRevenueAmt |
| CY Other Revenue | $120,796 | CYOtherRevenueAmt |
| PY Total Revenue | $5,672,000 | PYTotalRevenueAmt |
| CY Total Revenue | $5,323,315 | CYTotalRevenueAmt |
| PY Grants And Similar Paid | $2,430 | PYGrantsAndSimilarPaidAmt |
| CY Grants And Similar Paid | $1,125 | CYGrantsAndSimilarPaidAmt |
| PY Benefits Paid To Members | $0 | PYBenefitsPaidToMembersAmt |
| CY Benefits Paid To Members | $0 | CYBenefitsPaidToMembersAmt |
| PY Salaries Comp Emp Bnft Paid | $2,414,947 | PYSalariesCompEmpBnftPaidAmt |
| CY Salaries Comp Emp Bnft Paid | $2,538,966 | CYSalariesCompEmpBnftPaidAmt |
| PY Total Prof Fndrsng Expns | $0 | PYTotalProfFndrsngExpnsAmt |
| CY Total Prof Fndrsng Expns | $0 | CYTotalProfFndrsngExpnsAmt |
| CY Total Fundraising Expense | $0 | CYTotalFundraisingExpenseAmt |
| PY Other Expenses | $1,995,400 | PYOtherExpensesAmt |
| CY Other Expenses | $2,088,153 | CYOtherExpensesAmt |
| PY Total Expenses | $4,412,777 | PYTotalExpensesAmt |
| CY Total Expenses | $4,628,244 | CYTotalExpensesAmt |
| PY Revenues Less Expenses | $1,259,223 | PYRevenuesLessExpensesAmt |
| CY Revenues Less Expenses | $695,071 | CYRevenuesLessExpensesAmt |
| Total Assets BOY | $5,533,647 | TotalAssetsBOYAmt |
| Total Assets EOY | $7,556,829 | TotalAssetsEOYAmt |
| Total Liabilities BOY | $413,368 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $1,641,977 | TotalLiabilitiesEOYAmt |
| Net Assets Or Fund Balances BOY | $5,120,279 | NetAssetsOrFundBalancesBOYAmt |
| Net Assets Or Fund Balances EOY | $5,914,852 | NetAssetsOrFundBalancesEOYAmt |
| Info In Schedule O Part III | Yes (X) | InfoInScheduleOPartIIIInd |
| Mission | EXCELLENCE IN THE PROVISION OF HEALTH CARE AND RELATED SERVICES, GOVERNED AS A NOT-FOR-PROFIT COMMUNITY ORGANIZATION, SERVING THE NEEDS OF OUR PEOPLE WITH SUPERIOR QUALITY AND VALUE. | MissionDesc |
| Significant New Program Srvc | 0 | SignificantNewProgramSrvcInd |
| Significant Change | 0 | SignificantChangeInd |
| Expense | $3,977,368 | ExpenseAmt |
| Grant | $1,125 | GrantAmt |
| Revenue | $4,803,194 | RevenueAmt |
| Desc | COMMUNITY MEMORIAL HOSPITAL, INC., A 16-BED ACUTE CARE HOSPITAL, PROMOTES HEALTH OF THE COMMUNITY BY PROVIDING A VARIETY OF HEALTH CARE SERVICES. DURING 2017, COMMUNITY MEMORIAL HOSPITAL HAD 4,170 CLINIC VISITS IN BURKE AND 549 CLINIC VISITS IN BONESTEEL. THE HOSPITAL HAD 125 ADMISSIONS, 331 PATIENT DAYS, AND 958 SWINGBED DAYS.COMMUNITY MEMORIAL HOSPITAL HAS TAKEN STEPS TO ENHANCE PREVENTIVE CARE ON A YEARLY BASIS FOR PEOPLE OF ALL AGES THROUGH THE DEVELOPMENT OF SPECIALTY CLINICS TO ENSURE THAT THOSE WHO COME HERE FOR PREVENTIVE CARE RECEIVE THE SCREENINGS AND RECOMMENDATIONS APPROPRIATE TO THEIR PERSONAL AND FAMILY HISTORY. JUST A FEW OF THE SPECIALTY CLINICS PROVIDED ARE A WOMEN'S HEALTH CLINIC, VASCULAR SCREENING CLINIC, FLU CLINIC, AND A SKIN CLINIC. FREE CHOLESTEROL SCREENINGS ARE OFFERED TWICE PER YEAR. COMMUNITY MEMORIAL HOSPITAL TAKES GREAT PRIDE IN THE CARE PROVIDED TO THE COMMUNITY IT SERVES. | Desc |
| Total Program Service Expenses | $3,977,368 | TotalProgramServiceExpensesAmt |
| Described In Section501c3 | Yes (1) | DescribedInSection501c3Ind |
| Schedule B Required | Yes (1) | ScheduleBRequiredInd |
| Political Campaign Acty | 0 | PoliticalCampaignActyInd |
| Lobbying Activities | 0 | LobbyingActivitiesInd |
| Subject To Proxy Tax | 0 | SubjectToProxyTaxInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Conservation Easements | 0 | ConservationEasementsInd |
| Collections Of Art | 0 | CollectionsOfArtInd |
| Credit Counseling | 0 | CreditCounselingInd |
| Temp Or Permanent Endowments | 0 | TempOrPermanentEndowmentsInd |
| Report Land Building Equipment | Yes (1) | ReportLandBuildingEquipmentInd |
| Report Investments Other Sec | 0 | ReportInvestmentsOtherSecInd |
| Report Program Related Invst | 0 | ReportProgramRelatedInvstInd |
| Report Other Assets | Yes (1) | ReportOtherAssetsInd |
| Report Other Liabilities | 0 | ReportOtherLiabilitiesInd |
| Include FIN48 Footnote | Yes (1) | IncludeFIN48FootnoteInd |
| Independent Audit Fincl Stmt | Yes (1) | IndependentAuditFinclStmtInd |
| Consolidated Audit Fincl Stmt | 0 | ConsolidatedAuditFinclStmtInd |
| School Operating | 0 | SchoolOperatingInd |
| Foreign Office | 0 | ForeignOfficeInd |
| Foreign Activities | 0 | ForeignActivitiesInd |
| More Than5000 K To Org | 0 | MoreThan5000KToOrgInd |
| More Than5000 K To Individuals | 0 | MoreThan5000KToIndividualsInd |
| Professional Fundraising | 0 | ProfessionalFundraisingInd |
| Fundraising Activities | Yes (1) | FundraisingActivitiesInd |
| Gaming Activities | 0 | GamingActivitiesInd |
| Operate Hospital | Yes (1) | OperateHospitalInd |
| Audited Financial Stmt Att | Yes (1) | AuditedFinancialStmtAttInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Schedule J Required | 0 | ScheduleJRequiredInd |
| Tax Exempt Bonds | 0 | TaxExemptBondsInd |
| Engaged In Excess Benefit Trans | 0 | EngagedInExcessBenefitTransInd |
| PY Excess Benefit Trans | 0 | PYExcessBenefitTransInd |
| Loan Outstanding | 0 | LoanOutstandingInd |
| Grant To Related Person | 0 | GrantToRelatedPersonInd |
| Business Rln With Org Mem | 0 | BusinessRlnWithOrgMemInd |
| Business Rln With Fam Mem | Yes (1) | BusinessRlnWithFamMemInd |
| Business Rln With Officer Ent | 0 | BusinessRlnWithOfficerEntInd |
| Deductible Non Cash Contri | Yes (1) | DeductibleNonCashContriInd |
| Deductible Art Contribution | 0 | DeductibleArtContributionInd |
| Terminate Operations | 0 | TerminateOperationsInd |
| Partial Liquidation | 0 | PartialLiquidationInd |
| Disregarded Entity | 0 | DisregardedEntityInd |
| Related Entity | 0 | RelatedEntityInd |
| Related Organization Ctrl Ent | 0 | RelatedOrganizationCtrlEntInd |
| Trnsfr Exmpt Non Chrtbl Rltd Org | 0 | TrnsfrExmptNonChrtblRltdOrgInd |
| Activities Conducted Prtshp | 0 | ActivitiesConductedPrtshpInd |
| Schedule O Required | Yes (1) | ScheduleORequiredInd |
| IRP Document | 13 | IRPDocumentCnt |
| IRP Document W2 G | 0 | IRPDocumentW2GCnt |
| Backup Wthld Compliance | Yes (1) | BackupWthldComplianceInd |
| Employee | 65 | EmployeeCnt |
| Employment Tax Returns Filed | Yes (1) | EmploymentTaxReturnsFiledInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Foreign Financial Account | 0 | ForeignFinancialAccountInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
| Taxable Party Notification | 0 | TaxablePartyNotificationInd |
| Nondeductible Contributions | 0 | NondeductibleContributionsInd |
| Quid Pro Quo Contributions | 0 | QuidProQuoContributionsInd |
| Form8282 Property Disposed Of | 0 | Form8282PropertyDisposedOfInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Indoor Tanning Services | 0 | IndoorTanningServicesInd |
| Info In Schedule O Part VI | Yes (X) | InfoInScheduleOPartVIInd |
| Governing Body Voting Members | 9 | GoverningBodyVotingMembersCnt |
| Independent Voting Member | 4 | IndependentVotingMemberCnt |
| Family Or Business Rln | 0 | FamilyOrBusinessRlnInd |
| Delegation Of Mgmt Duties | Yes (1) | DelegationOfMgmtDutiesInd |
| Change To Org Documents | 0 | ChangeToOrgDocumentsInd |
| Material Diversion Or Misuse | 0 | MaterialDiversionOrMisuseInd |
| Members Or Stockholders | Yes (1) | MembersOrStockholdersInd |
| Election Of Board Members | Yes (1) | ElectionOfBoardMembersInd |
| Decisions Subject To Approva | Yes (1) | DecisionsSubjectToApprovaInd |
| Minutes Of Governing Body | Yes (1) | MinutesOfGoverningBodyInd |
| Minutes Of Committees | 0 | MinutesOfCommitteesInd |
| Officer Mailing Address | 0 | OfficerMailingAddressInd |
| Local Chapters | 0 | LocalChaptersInd |
| Form990 Provided To Gvrn Body | Yes (1) | Form990ProvidedToGvrnBodyInd |
| Conflict Of Interest Policy | Yes (1) | ConflictOfInterestPolicyInd |
| Annual Disclosure Covered Prsn | Yes (1) | AnnualDisclosureCoveredPrsnInd |
| Regular Monitoring Enfrc | Yes (1) | RegularMonitoringEnfrcInd |
| Whistleblower Policy | Yes (1) | WhistleblowerPolicyInd |
| Document Retention Policy | Yes (1) | DocumentRetentionPolicyInd |
| Compensation Process CEO | Yes (1) | CompensationProcessCEOInd |
| Compensation Process Other | 0 | CompensationProcessOtherInd |
| Investment In Joint Venture | 0 | InvestmentInJointVentureInd |
| Own Website | Yes (X) | OwnWebsiteInd |
| Upon Request | Yes (X) | UponRequestInd |
Books In Care Of Detail BooksInCareOfDetail
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | TAMI LYON | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 6057752621 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 319 | AddressLine1Txt |
| City | BURKE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 575230319 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part VII | Yes (X) | InfoInScheduleOPartVIIInd |
| No Listed Persons Compensated | Yes (X) | NoListedPersonsCompensatedInd |
Form990 Part VII Section A Form990PartVIISectionAGrp (11 entries)
| TitleTitleTxt | Average Hours Per WeekAverageHoursPerWeekRt | Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd | OfficerOfficerInd | Reportable Comp From OrgReportableCompFromOrgAmt | Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt | Other CompensationOtherCompensationAmt | Highest Compensated EmployeeHighestCompensatedEmployeeInd |
|---|---|---|---|---|---|---|---|
| TOM GLOVER | |||||||
| CHAIRMAN | 2.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| JIM WATERBURY | |||||||
| VICE CHAIRMAN | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| KAREN MARTIN | |||||||
| SECRETARY/TREASURER | 1.00 | Yes (X) | Yes (X) | $0 | $0 | $0 | |
| AJ STEFFEN | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| RICH DOBESH | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MICHAEL KARBO | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| CLAYTON STEELE | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| KATE WITT | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| SUE CHYTKA | |||||||
| DIRECTOR | 1.00 | Yes (X) | $0 | $0 | $0 | ||
| MISTIE SACHTJEN | |||||||
| CEO | 40.00 | Yes (X) | $0 | $0 | $0 | ||
| DEB LEIBEL | |||||||
| CNP | 40.00 | $113,517 | $0 | $16,645 | Yes (X) | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | $113,517 | TotalReportableCompFromOrgAmt |
| Tot Reportable Comp Rltd Org | $0 | TotReportableCompRltdOrgAmt |
| Total Other Compensation | $16,645 | TotalOtherCompensationAmt |
| Indiv Rcvd Greater Than100 K | 1 | IndivRcvdGreaterThan100KCnt |
| Former Ofcr Employees Listed | 0 | FormerOfcrEmployeesListedInd |
| Total Comp Greater Than150 K | 0 | TotalCompGreaterThan150KInd |
| Compensation From Other Srcs | 0 | CompensationFromOtherSrcsInd |
Contractor Compensation ContractorCompensationGrp (5 entries)
| Address Line1ContractorAddress/USAddress/AddressLine1Txt | CityContractorAddress/USAddress/CityNm | State AbbreviationContractorAddress/USAddress/StateAbbreviationCd | ZIPContractorAddress/USAddress/ZIPCd | ServicesServicesDesc | CompensationCompensationAmt |
|---|---|---|---|---|---|
| SANFORD HEALTH | |||||
| PO BOX 5074 | SIOUX FALLS | SD | 571175074 | MANAGEMENT FEES, CEO WAGES | $395,774 |
| SANFORD CLINIC | |||||
| 1305 W 18TH ST | SIOUX FALLS | SD | 57105 | MD WAGES | $253,059 |
| ARCHITECTURE INCORPORATED | |||||
| PO BOX 2140 | SIOUX FALLS | SD | 571012140 | BUILDING PROJECT | $220,377 |
| CARDINAL HEALTH | |||||
| PO BOX 70539 | CHICAGO | IL | 60673 | MEDICAL DRUGS/SUPPLIES | $213,276 |
| WINNER PHYSICAL THERAPY | |||||
| PO BOX 435 | WINNER | SD | 57580 | PT COVERAGE FOR IN HOUSE PATIENTS | $120,910 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cntrct Rcvd Greater Than100 K | 6 | CntrctRcvdGreaterThan100KCnt |
| Fundraising | $14,791 | FundraisingAmt |
| Government Grants | $17,458 | GovernmentGrantsAmt |
| All Other Contributions | $369,132 | AllOtherContributionsAmt |
| Noncash Contributions | $297,100 | NoncashContributionsAmt |
| Total Contributions | $401,381 | TotalContributionsAmt |
Program Service Revenue ProgramServiceRevenueGrp (3 entries)
| DescDesc | BusinessBusinessCd | Total Revenue ColumnTotalRevenueColumnAmt | Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt |
|---|---|---|---|
| PATIENT SERVICE REVENU | 621110 | $3,569,270 | $3,569,270 |
| CLINIC REVENUE | 621498 | $914,557 | $914,557 |
| PHARMACY REVENUE | 446110 | $146,000 | $146,000 |
Total Oth Program Service Rev TotalOthProgramServiceRevGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $109,767 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $109,767 | RelatedOrExemptFuncIncomeAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Program Service Revenue | $4,739,594 | TotalProgramServiceRevenueAmt |
Investment Income InvestmentIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $61,044 | TotalRevenueColumnAmt |
| Exclusion | $61,044 | ExclusionAmt |
Gross Rents GrossRentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $63,600 | RealAmt |
Less Rental Expenses LessRentalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $0 | RealAmt |
Rental Income Or Loss RentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | $63,600 | RealAmt |
Net Rental Income Or Loss NetRentalIncomeOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $63,600 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $63,600 | RelatedOrExemptFuncIncomeAmt |
Gross Amount Sales Assets GrossAmountSalesAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $500 | OtherAmt |
Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $0 | OtherAmt |
Gain Or Loss GainOrLossGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | $500 | OtherAmt |
Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $500 | TotalRevenueColumnAmt |
| Exclusion | $500 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Fundraising Gross Income | $63,806 | FundraisingGrossIncomeAmt |
| Contri Rpt Fundraising Event | $14,791 | ContriRptFundraisingEventAmt |
| Fundraising Direct Expenses | $6,610 | FundraisingDirectExpensesAmt |
Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $57,196 | TotalRevenueColumnAmt |
| Exclusion | $57,196 | ExclusionAmt |
Total Revenue TotalRevenueGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | $5,323,315 | TotalRevenueColumnAmt |
| Related Or Exempt Func Income | $4,803,194 | RelatedOrExemptFuncIncomeAmt |
| Unrelated Business Revenue | $0 | UnrelatedBusinessRevenueAmt |
| Exclusion | $118,740 | ExclusionAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Info In Schedule O Part IX | Yes (X) | InfoInScheduleOPartIXInd |
Grants To Domestic Orgs GrantsToDomesticOrgsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $950 | TotalAmt |
| Program Services | $950 | ProgramServicesAmt |
Grants To Domestic Individuals GrantsToDomesticIndividualsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $175 | TotalAmt |
| Program Services | $175 | ProgramServicesAmt |
Comp Disqual Persons CompDisqualPersonsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $383,380 | TotalAmt |
| Program Services | $383,380 | ProgramServicesAmt |
Other Salaries And Wages OtherSalariesAndWagesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $1,696,766 | TotalAmt |
| Program Services | $1,528,559 | ProgramServicesAmt |
| Management And General | $168,207 | ManagementAndGeneralAmt |
Pension Plan Contributions PensionPlanContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $51,167 | TotalAmt |
| Program Services | $47,029 | ProgramServicesAmt |
| Management And General | $4,138 | ManagementAndGeneralAmt |
Other Employee Benefits OtherEmployeeBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $257,445 | TotalAmt |
| Program Services | $236,627 | ProgramServicesAmt |
| Management And General | $20,818 | ManagementAndGeneralAmt |
Payroll Taxes PayrollTaxesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $150,208 | TotalAmt |
| Program Services | $138,062 | ProgramServicesAmt |
| Management And General | $12,146 | ManagementAndGeneralAmt |
Fees For Services Management FeesForServicesManagementGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $170,036 | TotalAmt |
| Management And General | $170,036 | ManagementAndGeneralAmt |
Fees For Services Legal FeesForServicesLegalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $6,695 | TotalAmt |
| Management And General | $6,695 | ManagementAndGeneralAmt |
Fees For Services Other FeesForServicesOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $897,748 | TotalAmt |
| Program Services | $817,330 | ProgramServicesAmt |
| Management And General | $80,418 | ManagementAndGeneralAmt |
Advertising AdvertisingGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $10,471 | TotalAmt |
| Program Services | $3,554 | ProgramServicesAmt |
| Management And General | $6,917 | ManagementAndGeneralAmt |
Office Expenses OfficeExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $74,538 | TotalAmt |
| Program Services | $56,690 | ProgramServicesAmt |
| Management And General | $17,848 | ManagementAndGeneralAmt |
Information Technology InformationTechnologyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $104,458 | TotalAmt |
| Management And General | $104,458 | ManagementAndGeneralAmt |
Occupancy OccupancyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $48,140 | TotalAmt |
| Program Services | $44,904 | ProgramServicesAmt |
| Management And General | $3,236 | ManagementAndGeneralAmt |
Travel TravelGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $8,418 | TotalAmt |
| Program Services | $7,300 | ProgramServicesAmt |
| Management And General | $1,118 | ManagementAndGeneralAmt |
Conferences Meetings ConferencesMeetingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $19,437 | TotalAmt |
| Program Services | $8,406 | ProgramServicesAmt |
| Management And General | $11,031 | ManagementAndGeneralAmt |
Depreciation Depletion DepreciationDepletionGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $145,795 | TotalAmt |
| Program Services | $145,795 | ProgramServicesAmt |
Insurance InsuranceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $26,797 | TotalAmt |
| Management And General | $26,797 | ManagementAndGeneralAmt |
Other Expenses OtherExpensesGrp (4 entries)
| DescDesc | TotalTotalAmt | Program ServicesProgramServicesAmt | Management And GeneralManagementAndGeneralAmt |
|---|---|---|---|
| MEDICAL SUPPLIES | $421,733 | $421,733 | |
| BAD DEBT EXPENSE | $100,843 | $100,843 | |
| EQUIPMENT & MAINTENANCE | $26,617 | $22,459 | $4,158 |
| LICENSES, DUES & SUBSCR | $13,339 | $8,472 | $4,867 |
All Other Expenses AllOtherExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $13,088 | TotalAmt |
| Program Services | $5,100 | ProgramServicesAmt |
| Management And General | $7,988 | ManagementAndGeneralAmt |
Total Functional Expenses TotalFunctionalExpensesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $4,628,244 | TotalAmt |
| Program Services | $3,977,368 | ProgramServicesAmt |
| Management And General | $650,876 | ManagementAndGeneralAmt |
| Fundraising | $0 | FundraisingAmt |
Savings And Temp Cash Invst SavingsAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $2,937,121 | BOYAmt |
| EOY | $2,497,829 | EOYAmt |
Pledges And Grants Receivable PledgesAndGrantsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $517,290 | BOYAmt |
| EOY | $377,757 | EOYAmt |
Accounts Receivable AccountsReceivableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $650,832 | BOYAmt |
| EOY | $528,206 | EOYAmt |
Inventories For Sale Or Use InventoriesForSaleOrUseGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $85,934 | BOYAmt |
| EOY | $85,351 | EOYAmt |
Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $41,307 | BOYAmt |
| EOY | $41,523 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Land Bldg Equip Cost Or Other Bss | $5,389,202 | LandBldgEquipCostOrOtherBssAmt |
| Land Bldg Equip Accum Deprec | $2,603,720 | LandBldgEquipAccumDeprecAmt |
Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $715,251 | BOYAmt |
| EOY | $2,785,482 | EOYAmt |
Investments Pub Traded Sec InvestmentsPubTradedSecGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $576,770 | BOYAmt |
| EOY | $840,587 | EOYAmt |
Investments Other Securities InvestmentsOtherSecuritiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $9,142 | BOYAmt |
| EOY | $9,899 | EOYAmt |
Other Assets Total OtherAssetsTotalGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $390,195 | EOYAmt |
Total Assets TotalAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,533,647 | BOYAmt |
| EOY | $7,556,829 | EOYAmt |
Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $366,368 | BOYAmt |
| EOY | $751,958 | EOYAmt |
Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $0 | BOYAmt |
| EOY | $890,019 | EOYAmt |
Other Liabilities OtherLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $47,000 | BOYAmt |
| EOY | $0 | EOYAmt |
Total Liabilities TotalLiabilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $413,368 | BOYAmt |
| EOY | $1,641,977 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization Follows SFAS117 | Yes (X) | OrganizationFollowsSFAS117Ind |
Unrestricted Net Assets UnrestrictedNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $4,172,562 | BOYAmt |
| EOY | $5,530,553 | EOYAmt |
Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $947,717 | BOYAmt |
| EOY | $384,299 | EOYAmt |
Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,120,279 | BOYAmt |
| EOY | $5,914,852 | EOYAmt |
Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | $5,533,647 | BOYAmt |
| EOY | $7,556,829 | EOYAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expnss | $695,071 | ReconcilationRevenueExpnssAmt |
| Net Unrlzd Gains Losses Invst | $99,502 | NetUnrlzdGainsLossesInvstAmt |
| Other Changes In Net Assets | $0 | OtherChangesInNetAssetsAmt |
| Method Of Accounting Accrual | Yes (X) | MethodOfAccountingAccrualInd |
| Accountant Compile Or Review | 0 | AccountantCompileOrReviewInd |
| FS Audited | Yes (1) | FSAuditedInd |
FS Audited Basis FSAuditedBasisGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Separate Basis Fincl Stmt | Yes (X) | SeparateBasisFinclStmtInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | Yes (1) | AuditCommitteeInd |
| Federal Grant Audit Required | 0 | FederalGrantAuditRequiredInd |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Hospital | Yes (X) | HospitalInd |
Schedule B IRS990ScheduleB
Schedule D IRS990ScheduleD
Land LandGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $44,228 | OtherCostOrOtherBasisAmt |
| Book Value | $44,228 | BookValueAmt |
Buildings BuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,463,165 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,385,776 | DepreciationAmt |
| Book Value | $77,389 | BookValueAmt |
Equipment EquipmentGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $1,817,254 | OtherCostOrOtherBasisAmt |
| Depreciation | $1,176,810 | DepreciationAmt |
| Book Value | $640,444 | BookValueAmt |
Other Land Buildings OtherLandBuildingsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other Cost Or Other Basis | $2,064,555 | OtherCostOrOtherBasisAmt |
| Depreciation | $41,134 | DepreciationAmt |
| Book Value | $2,023,421 | BookValueAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Land Buildings | $2,785,482 | TotalBookValueLandBuildingsAmt |
Other Assets Org OtherAssetsOrgGrp (2 entries)
| DescDesc | Book ValueBookValueAmt |
|---|---|
| THIRD PARTY PAYOR SETTLEMENT | $156,000 |
| RESERVE FUND | $234,195 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Book Value Other Assets | $390,195 | TotalBookValueOtherAssetsAmt |
| Footnote Text | Yes (X) | FootnoteTextInd |
| Total Rev Etc Audited Fincl Stmt | $5,328,584 | TotalRevEtcAuditedFinclStmtAmt |
| Net Unrealized Gains Invst | $99,502 | NetUnrealizedGainsInvstAmt |
| Other Revenue | -$94,233 | OtherRevenueAmt |
| Revenue Not Reported | $5,269 | RevenueNotReportedAmt |
| Revenue Subtotal | $5,323,315 | RevenueSubtotalAmt |
| Revenue Not Reported Fincl Stmt | $0 | RevenueNotReportedFinclStmtAmt |
| Total Revenue Per Form990 | $5,323,315 | TotalRevenuePerForm990Amt |
| Tot Expns Etc Audited Fincl Stmt | $4,534,011 | TotExpnsEtcAuditedFinclStmtAmt |
| Other Expenses Included | -$94,233 | OtherExpensesIncludedAmt |
| Expenses Not Reported | -$94,233 | ExpensesNotReportedAmt |
| Expenses Subtotal | $4,628,244 | ExpensesSubtotalAmt |
| Expenses Not Rpt Fincl Stmt | $0 | ExpensesNotRptFinclStmtAmt |
| Total Expenses Per Form990 | $4,628,244 | TotalExpensesPerForm990Amt |
Supplemental Information Detail SupplementalInformationDetail (3 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART X, LINE 2: | THE HOSPITAL IS ORGANIZED AS A SOUTH DAKOTA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE AS EXEMPT FROM FEDERAL INCOME TAXES UNDER INTERNAL REVENUE SERVICE CODE SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION, THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORGANIZATION HAS DETERMINED IT IS NOT SUBJECT TO UNRELATED BUSINESS INCOME TAX AND HAS NOT FILED AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990-T) WITH THE IRS. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. |
| PART XI, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -100,843. FUNDRAISING EXPENSES 6,610. |
| PART XII, LINE 2D - OTHER ADJUSTMENTS: | BAD DEBT EXPENSE -100,843. FUNDRAISING EXPENSES 6,610. |
Schedule G IRS990ScheduleG
Fundraising Event Information FundraisingEventInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Event1 | 2017 GALA | Event1Nm |
| Gross Receipts Event1 | $71,969 | GrossReceiptsEvent1Amt |
| Charitable Contri Event1 | $9,795 | CharitableContriEvent1Amt |
| Gross Revenue Event1 | $62,174 | GrossRevenueEvent1Amt |
| Non Cash Prizes Event1 | $108 | NonCashPrizesEvent1Amt |
| Food And Beverage Event1 | $3,030 | FoodAndBeverageEvent1Amt |
| Other Direct Expenses Event1 | $2,183 | OtherDirectExpensesEvent1Amt |
| Event2 | GOLF TOURNAMENT | Event2Nm |
| Gross Receipts Event2 | $6,628 | GrossReceiptsEvent2Amt |
| Charitable Contri Event2 | $4,996 | CharitableContriEvent2Amt |
| Gross Revenue Event2 | $1,632 | GrossRevenueEvent2Amt |
| Cash Prizes Event2 | $200 | CashPrizesEvent2Amt |
| Rent Facility Costs Event2 | $480 | RentFacilityCostsEvent2Amt |
| Food And Beverage Event2 | $442 | FoodAndBeverageEvent2Amt |
| Other Direct Expenses Event2 | $167 | OtherDirectExpensesEvent2Amt |
| Gross Receipts Total | $78,597 | GrossReceiptsTotalAmt |
| Charitable Contributions Tot | $14,791 | CharitableContributionsTotAmt |
| Gross Revenue Total Events | $63,806 | GrossRevenueTotalEventsAmt |
| Cash Prizes Total Events | $200 | CashPrizesTotalEventsAmt |
| Non Cash Prizes Total Events | $108 | NonCashPrizesTotalEventsAmt |
| Rent Fclty Costs Total Events | $480 | RentFcltyCostsTotalEventsAmt |
| Food And Beverage Total Events | $3,472 | FoodAndBeverageTotalEventsAmt |
| Oth Direct Expnss Total Events | $2,350 | OthDirectExpnssTotalEventsAmt |
| Direct Expense Summary Events | $6,610 | DirectExpenseSummaryEventsAmt |
| Net Income Summary | $57,196 | NetIncomeSummaryAmt |
Schedule H IRS990ScheduleH
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Assistance Policy | Yes (1) | FinancialAssistancePolicyInd |
| Written Policy | Yes (1) | WrittenPolicyInd |
| All Hospitals Policy | Yes (X) | AllHospitalsPolicyInd |
| FPG Reference Free Care | Yes (1) | FPGReferenceFreeCareInd |
| Percent100 | Yes (X) | Percent100Ind |
| FPG Reference Discounted Care | Yes (1) | FPGReferenceDiscountedCareInd |
Discounted Care Oth Percentage DiscountedCareOthPercentageGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Discounted Care Other | 150.000000000000 | DiscountedCareOtherPct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Free Care Medically Indigent | Yes (1) | FreeCareMedicallyIndigentInd |
| Financial Assistance Budget | Yes (1) | FinancialAssistanceBudgetInd |
| Expenses Exceed Budget | Yes (1) | ExpensesExceedBudgetInd |
| Unable To Provide Care | 0 | UnableToProvideCareInd |
| Annual Community Bnft Report | Yes (1) | AnnualCommunityBnftReportInd |
| Report Publically Available | Yes (1) | ReportPublicallyAvailableInd |
Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Total Financial Assistance Typ TotalFinancialAssistanceTyp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $13,000 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $13,000 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00290 | TotalExpensePct |
Community Health Services CommunityHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $19,309 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $1,425 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $17,884 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00400 | TotalExpensePct |
Subsidized Health Services SubsidizedHealthServicesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,061,159 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $814,835 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $246,324 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05440 | TotalExpensePct |
Cash And In Kind Contributions CashAndInKindContributionsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,225 | TotalCommunityBenefitExpnsAmt |
| Net Community Benefit Expns | $1,225 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.00030 | TotalExpensePct |
Total Other Benefits TotalOtherBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,081,693 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $816,260 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $265,433 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.05870 | TotalExpensePct |
Total Community Benefits TotalCommunityBenefitsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Community Benefit Expns | $1,094,693 | TotalCommunityBenefitExpnsAmt |
| Direct Offsetting Revenue | $816,260 | DirectOffsettingRevenueAmt |
| Net Community Benefit Expns | $278,433 | NetCommunityBenefitExpnsAmt |
| Total Expense | 0.06160 | TotalExpensePct |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Bad Debt Expense Reported | 0 | BadDebtExpenseReportedInd |
| Bad Debt Expense | $100,843 | BadDebtExpenseAmt |
| Bad Debt Expense Attributable | $21,177 | BadDebtExpenseAttributableAmt |
| Reimbursed By Medicare | $2,288,409 | ReimbursedByMedicareAmt |
| Cost Of Care Reimbursed By Medcr | $2,304,637 | CostOfCareReimbursedByMedcrAmt |
| Medicare Surplus Or Shortfall | -$16,228 | MedicareSurplusOrShortfallAmt |
Costing Methodology Used CostingMethodologyUsedGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Other | Yes (X) | OtherInd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Written Debt Collection Policy | Yes (1) | WrittenDebtCollectionPolicyInd |
| Financial Assistance Prvsn | Yes (1) | FinancialAssistancePrvsnInd |
| Hospital Facilities | 1 | HospitalFacilitiesCnt |
Hospital Facilities HospitalFacilitiesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | PO BOX 319 | AddressLine1Txt |
| City | BURKE | CityNm |
| State Abbreviation | SD | StateAbbreviationCd |
| ZIP | 57523 | ZIPCd |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Website Address | WWW.BURKEHOSPITAL.COM | WebsiteAddressTxt |
| State License | 10530 | StateLicenseNum |
| Licensed Hospital | Yes (X) | LicensedHospitalInd |
| Critical Access Hospital | Yes (X) | CriticalAccessHospitalInd |
| Emergency Room24 Hrs | Yes (X) | EmergencyRoom24HrsInd |
| Other | 2 PROVIDER BASED RURAL HEALTH CLINICS | OtherDesc |
Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp
Hospital Facility Name HospitalFacilityName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | COMMUNITY MEMORIAL HOSPITAL INC | BusinessNameLine1Txt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Facility | 1 | FacilityNum |
| First Licensed CY Or PY | 0 | FirstLicensedCYOrPYInd |
| Tax Exempt Hospital CY Or PY | 0 | TaxExemptHospitalCYOrPYInd |
| CHNA Conducted | Yes (1) | CHNAConductedInd |
| Community Definition | Yes (X) | CommunityDefinitionInd |
| Community Demographics | Yes (X) | CommunityDemographicsInd |
| Existing Resources | Yes (X) | ExistingResourcesInd |
| How Data Obtained | Yes (X) | HowDataObtainedInd |
| Community Health Needs | Yes (X) | CommunityHealthNeedsInd |
| Other Health Issues | Yes (X) | OtherHealthIssuesInd |
| Community Hlth Needs Id Process | Yes (X) | CommunityHlthNeedsIdProcessInd |
| Consulting Process | Yes (X) | ConsultingProcessInd |
| Prior CHNA Impact | Yes (X) | PriorCHNAImpactInd |
| CHNA Conducted | 16 | CHNAConductedYr |
| Take Into Account Others Input | Yes (1) | TakeIntoAccountOthersInputInd |
| CHNA Conducted With Other Fclts | 0 | CHNAConductedWithOtherFcltsInd |
| CHNA Conducted With Non Fclts | 0 | CHNAConductedWithNonFcltsInd |
| CHNA Report Widely Available | Yes (1) | CHNAReportWidelyAvailableInd |
| Rpt Available On Own Website | Yes (X) | RptAvailableOnOwnWebsiteInd |
| Own Website URL | WWW.BURKEHOSPITAL.COM | OwnWebsiteURLTxt |
| Other Website | Yes (X) | OtherWebsiteInd |
| Other Website URL | HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/CHNA | OtherWebsiteURLTxt |
| Implementation Strategy Adopt | Yes (1) | ImplementationStrategyAdoptInd |
| Implementation Strategy Adpt | 16 | ImplementationStrategyAdptYr |
| Strategy Posted Website | Yes (1) | StrategyPostedWebsiteInd |
| Strategy Website URL | SEE 7A AND 7B ABOVE | StrategyWebsiteURLTxt |
| Organization Incur Excise Tax | 0 | OrganizationIncurExciseTaxInd |
| Elig Criteria Explained | Yes (1) | EligCriteriaExplainedInd |
| FPG Family Incm Lmt Free Dscnt | Yes (X) | FPGFamilyIncmLmtFreeDscntInd |
| FPG Family Incm Lmt Free Care | 100.000000000000 | FPGFamilyIncmLmtFreeCarePct |
| FPG Family Incm Lmt Dscnt Care | 150.000000000000 | FPGFamilyIncmLmtDscntCarePct |
| Asset Level Criteria | Yes (X) | AssetLevelCriteriaInd |
| Medical Indigency Criteria | Yes (X) | MedicalIndigencyCriteriaInd |
| Insurance Status Criteria | Yes (X) | InsuranceStatusCriteriaInd |
| Underinsurance Stat Criteria | Yes (X) | UnderinsuranceStatCriteriaInd |
| Other Criteria | Yes (X) | OtherCriteriaInd |
| Explained Basis | Yes (1) | ExplainedBasisInd |
| App Financial Asst Expln | Yes (1) | AppFinancialAsstExplnInd |
| Described Info | Yes (X) | DescribedInfoInd |
| Described Suprt Doc | Yes (X) | DescribedSuprtDocInd |
| Provided Hospital Contact | Yes (X) | ProvidedHospitalContactInd |
| Provided Nonprofit Contact | Yes (X) | ProvidedNonprofitContactInd |
| Other Method | Yes (X) | OtherMethodInd |
| Includes Publicity Measures | Yes (1) | IncludesPublicityMeasuresInd |
| FAP Available On Website | Yes (X) | FAPAvailableOnWebsiteInd |
| FAP Available On Website URL | SEE PART V, LINE 16J NARRATIVE | FAPAvailableOnWebsiteURLTxt |
| FAP App Available On Website | Yes (X) | FAPAppAvailableOnWebsiteInd |
| FAP App Available On Website URL | SEE PART V, LINE 16J NARRATIVE | FAPAppAvailableOnWebsiteURLTxt |
| FAP Summary On Website | Yes (X) | FAPSummaryOnWebsiteInd |
| FAP Summary On Website URL | SEE PART V, LINE 16J NARR | FAPSummaryOnWebsiteURLTxt |
| FAP Avlbl On Request No Charge | Yes (X) | FAPAvlblOnRequestNoChargeInd |
| FAP App Avlbl On Request No Chrg | Yes (X) | FAPAppAvlblOnRequestNoChrgInd |
| FAP Sum Avlbl On Request No Chrg | Yes (X) | FAPSumAvlblOnRequestNoChrgInd |
| Notified FAP Copy Bill Display | Yes (X) | NotifiedFAPCopyBillDisplayInd |
| Communtity Notified FAP | Yes (X) | CommuntityNotifiedFAPInd |
| Other Publicity | Yes (X) | OtherPublicityInd |
| FAP Actions On Nonpayment | Yes (1) | FAPActionsOnNonpaymentInd |
| Permit No Actions | Yes (X) | PermitNoActionsInd |
| Collection Activities | 0 | CollectionActivitiesInd |
| Provided Written Notice | Yes (X) | ProvidedWrittenNoticeInd |
| Made Effort Orally Notify | Yes (X) | MadeEffortOrallyNotifyInd |
| Processed FAP Application | Yes (X) | ProcessedFAPApplicationInd |
| Made Presumptive Elig Determ | Yes (X) | MadePresumptiveEligDetermInd |
| Nondis Emergency Care Policy | Yes (1) | NondisEmergencyCarePolicyInd |
| Look Back Medicare Private | Yes (X) | LookBackMedicarePrivateInd |
| Amounts Generally Billed | 0 | AmountsGenerallyBilledInd |
| Gross Charges | 0 | GrossChargesInd |
Supplemental Information SupplementalInformationGrp (5 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| COMMUNITY MEMORIAL HOSPITAL, INC | PART V, SECTION B, LINE 5: COMMUNITY MEMORIAL SURVEYED SEVERAL CROSS SECTIONS OF THE COMMUNITY INCLUDING THE CITY COUNCIL, STAFF OF THE BURKE PUBLIC SCHOOL, BURKE COMMUNITY CLUB, AND COUNTY EMPLOYEES, BOARD OF DIRECTORS, COMMUNITY MEMORIAL EMPLOYEES AND BANK EMPLOYEES. IN ADDITION A SURVEY LINK WAS PUBLISHED IN THE LOCAL PAPER FOR OTHER INTERESTED PARTIES TO COMPLETE IF THEY WERE INTERESTED. |
| COMMUNITY MEMORIAL HOSPITAL, INC | PART V, SECTION B, LINE 11: THE HOSPITAL INTENDS TO ADDRESS ALL NEEDS PRIORITIZED IN ITS IMPLEMENTATION STRATEGY. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS REVIEWED AND APPROVED BY THE BOARD DURING ITS OCTOBER 2016 MEETING. THE IMPLEMENTATION STRATEGY WAS APPROVED IN THE MARCH 2017 BOARD MEETING. MEASURABLE OUTCOMES WILL BE REVIEWED ANNUALLY FROM 2017-2019 FOR THE FOLLOWING: PRIORITY 1: PHYSICAL HEALTH. AS A HEALTH CARE FACILITY WE ARE COMMITTED TO PROMOTING HEALTHY LIFESTYLE & ENCOURAGING OUR PATIENTS TO BE MORE ACTIVE. WE HAVE BEEN AND CONTINUE TO WORK WITH OUR LOCAL FITNESS ORGANIZATION AND COVER THE COST OF VARIOUS EXERCISE CLASSES AT NO CHARGE TO THE PUBLIC AND WILL CONTINUE TO IMPROVE ON THOSE SERVICES. WE CONTINUE TO OFFER FREE OR DISCOUNTED COMMUNITY HEALTH FAIRS FOR A VARIETY OF SCREENINGS, LAB TEST, ETC. IN APRIL 2017 OUR STAFF MET WITH MEMBERS OF THE BURKE SCHOOL DISTRICT TO PROMOTE ACTIVE LIFESTYLES OF OUR YOUTH WITH THE SANFORDFIT PROGRAM. THE SANFORDFFIT PROGRAM IS A FREE RESOURCE AVAILABLE TO PROMOTE MOVEMENT AND HEALTHY EATING, AS WELL AS OTHER FUN ACTIVITIES. PRIORITY 2: MENTAL HEALTH. SERIOUS ISSUES CAN ARISE FROM NOT ADDRESSING MENTAL HEALTH PROBLEMS WITH THE INDIVIDUAL OR THEIR FAMILIES. MENTAL HEALTH EFFECTS PEOPLE OF ALL AGES. OUR FOCUS WILL BE TO IMPROVE ACCESS TO MENTAL HEALTH SERVICES AS WELL AS IMPROVING CARE FOR PATIENTS WITH DEPRESSION. MENTAL HEALTH FIRST AID COURSES FOR STAFF ARE OUR FIRST STEPS IN WORKING ON THE MENTAL HEALTH OF THE COMMUNITY. LATE FALL OF 2017, 2 OF OUR MANAGEMENT EMPLOYEES ATTENDED AN 8-HOUR COURSE THAT GIVES PEOPLE THE SKILLS TO HELP SOMEONE WHO IS DEVELOPING A MENTAL HEALTH PROBLEM OR EXPERIENCING A MENTAL HEALTH CRISIS. THE EVIDENCE BEHIND MENTAL HEALTH FIRST AID IS TO BUILD MENTAL HEALTH LITERACY, HELP THE PUBLIC IDENTIFY, UNDERSTAND, AND RESPOND TO SIGNS OF MENTAL ILLNESS. IN OCTOBER 2018, WE HAVE 5 EMPLOYEES ATTENDING A 5-DAY MENTAL HEALTH FIRST AID TRAIN THE TRAINOR COURSE. ONCE THEY HAVE THE NECESSARY TRAINING, THEY WILL BRING THAT KNOWLEDGE BACK TO THE REMAINING STAFF SO EVERYONE CAN HELP THOSE SUFFERING FROM MENTAL ILLNESS. WE WILL ALSO HOLD A PUBLIC COURSE TO TRAIN COMMUNITY MEMBERS ON WARNING SIGNS. ANOTHER FOCUS WILL BE ON DRUG USE WITHIN THE COMMUNITY; MAINLY OPIOID MISUSE. REVISIONS HAVE BEEN MADE TO THE HOSPITAL POLICY FOR CONTROLLED SUBSTANCES AND OPIOID PRESCRIPTIONS. COLLABORATIONS HAVE ALSO BEGUN AMONGST VARIOUS FACILITY PROFESSIONALS IN DEVELOPING PLANS TO REDUCE OPIOID PRESCRIPTIONS. |
| COMMUNITY MEMORIAL HOSPITAL, INC | PART V, SECTION B, LINE 13H: PATIENTS WHOSE FAMILY INCOME EXCEEDS 150% OF THE FPL MAY BE ELIGIBLE TO RECEIVE DISCOUNTED RATES ON A CASE-BY-CASE BASIS BASED ON THEIR SPECIFIC CIRCUMSTANCES, SUCH AS CATASTROPHIC ILLNESS OR MEDICAL INDIGENCE; HOWEVER, THE DISCOUNTED RATES SHALL NOT BE GREATER THAN THE AMOUNTS GENERALLY BILLED COMMERCIALLY INSURED PATIENTS. |
| COMMUNITY MEMORIAL HOSPITAL, INC | PART V, SECTION B, LINE 15E: THE HOSPITAL PHONE NUMBER IS LISTED ON THE APPLICATION. THIS NUMBER DIRECTS THE PATIENT TO SOMEONE WHO CAN HELP WITH THE APPLICATION. IN THE HOSPITAL'S BUSINESS OFFICE THERE IS INFORMATION REGARDING OTHER ORGANIZATION OR GOVERNMENT AGENCIES TO HELP WITH OTHER ASSISTANCE. THE HOSPITAL OFFERS THE INFORMATION TO PATIENTS WHO MAY BENEFIT FROM IT. |
| COMMUNITY MEMORIAL HOSPITAL, INC | PART V, SECTION B, LINE 16J: PART V, LINE 16A, 16B, & 16C:THE POLICY, PLAIN LANGUAGE SUMMARY AND APPLICATION ARE POSTED TO THE WEBSITE AT WWW.BURKEHOSPITAL.COM; WWW.SANFORDHEALTH.ORG/LOCATIONS/COMMUNITY-MEMORIAL-HOSPITAL.PART V, LINE 16J: FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE AVAILABLE IN THE ER, CLINIC AND HOSPITAL ADMISSION OFFICE. THE POLICY AND APPLICATION ARE LOCATED AT THE COUNTY WELFARE OFFICE. A SIGN IS POSTED IN THE ADMISSIONS AREA TO INFORM PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. THE HOSPITAL PROVIDES A COPY OR SUMMARY OF THE POLICY TO PATIENTS WHO MAY QUALIFY UNDER THE FINANCIAL ASSISTANCE POLICY.LESS THAN FIVE PERCENT OF THE POPULATION, AND FEWER THAN 1,000 INDIVIDUALS IN THE SERVICE AREA SPEAK A LANGUAGE OTHER THAN ENGLISH AS THEIR PRIMARY LANGUAGE. |
Supplemental Information Detail SupplementalInformationDetail (13 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| PART I, LINE 3C: | INDIVIDUALS WILL NOT BE DENIED CHARITY CARE BASED ON RACE, CREED, SEX, NATIONAL ORIGIN, DISABILITY, AGE OR ABILITY TO PAY. BUSINESS OFFICE STAFF TRY TO IDENTIFY ELIGIBLE INDIVIDUALS AT THE TIME OF ADMISSION, HOWEVER INDIVIDUALS CAN BECOME ELIGIBLE FOR CHARITY CARE AT ANY POINT DURING OR AFTER THEIR MEDICAL ENCOUNTER. ONCE AN INDIVIDUAL IS IDENTIFIED AS A POTENTIAL CHARITY CARE RECIPIENT, COMMUNITY MEMORIAL HOSPITAL UTILIZES BOTH AN INCOME AND AN ASSET TEST TO EVALUATE ELIGIBILITY FOR CHARITY CARE. THE HOSPITAL REVIEWS A SCHEDULE OF THE PATIENT'S CURRENT INCOME AND EXPENSES AND ASSET LEVELS TO DETERMINE IF THE PATIENT CAN REASONABLY BE EXPECTED TO MAKE PAYMENT OF MEDICAL EXPENSES. |
| PART I, LINE 6A: | COMMUNITY MEMORIAL HOSPITAL MAKES THE COMMUNITY BENEFIT REPORT AVAILABLE TO THE PUBLIC THROUGH THE WEBSITE (HTTP://WWW.SANFORDHEALTH.ORG/ABOUT/COMMUNITY-BENEFIT/COMMUNITY-BENEFIT-ANNUAL-REPORT) AND AVAILABLE UPON REQUEST. |
| PART I, LINE 7: | CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A BASED ON AN OVERALL COST-TO-CHARGE RATIO ADDRESSING ALL PATIENT SEGMENTS. LINE 7E AND LINE 7I WERE OBTAINED UTILIZING THE ACTUAL GENERAL LEDGER SYSTEM. LINE 7G WAS OBTAINED FROM THE MEDICARE COST REPORT.RURAL HEALTH CLINIC NET REVENUES OF $711,662 AND COSTS OF $934,807 WERE INCLUDED ON LINE 7G FOR A NET COMMUNITY BENEFIT OF $223,145. |
| PART I, LN 7 COL(F): | THE AMOUNT OF BAD DEBT EXPENSE BASED ON CHARGES OF $100,843 WAS SUBTRACTED FROM TOTAL OPERATING EXPENSE. |
| PART III, LINE 2: | BAD DEBT WRITE-OFFS ARE RECORDED USING GROSS CHARGES. IF AN ACCOUNT IS WRITTEN OFF TO BAD DEBTS, PAYMENTS RECEIVED AFTER THE WRITE OFF OF THE ACCOUNT ARE POSTED TO THE ALLOWANCE FOR BAD DEBT ACCOUNT. THE ALLOWANCE FOR BAD DEBT IS CALCULATED USING AN ESTIMATED UNCOLLECTIBLE PERCENTAGE OF ACCOUNTS RECEIVABLE. THE DIFFERENCE BETWEEN THE ESTIMATE AND THE AMOUNT RECORDED TO THE ALLOWANCE FOR BAD DEBT IS RECORDED TO BAD DEBT EXPENSE.BAD DEBT EXPENSE REPORTED ON LINE 2 IS AT CHARGES AS REPORTED ON THE FINANCIAL STATEMENTS. |
| PART III, LINE 3: | BAD DEBT EXPENSE ATTRIBUTABLE TO CHARITY CARE IS ESTIMATED BASED AVERAGING THE COUNTY AND CITY US CENSUS BUREAU REPORTS OF INDIVIDUALS LIVING BELOW THE POVERTY LEVEL. 21% CAN REASONABLY BE CONSIDERED A COMMUNITY BENEFIT AS IT WOULD HAVE BEEN WRITTEN OFF TO CHARITY CARE. |
| PART III, LINE 4: | FOOTNOTE FROM FINANCIAL STATEMENT: PLEASE SEE NOTE 1, FINANCIAL STATEMENT, PATIENT RECEIVABLES ON PAGES 7-8. |
| PART III, LINE 8: | MEDICARE ALLOWABLE COSTS OF CARE WAS CALCULATED FROM THE MEDICARE COST REPORT FOR FISCAL YEAR ENDING 12/31/2017. MEDICAL SERVICES ARE PROVIDED TO PATIENTS WITH MEDICARE COVERAGE REGARDLESS OF WHETHER OR NOT A SURPLUS OR DEFICIT IS REALIZED. PROVIDING MEDICARE SERVICES PROMOTES ACCESS TO HEALTHCARE SERVICES WHICH ARE VITALLY NEEDED BY OUR COMMUNITY. |
| PART III, LINE 9B: | ONCE A DECISION HAS BEEN MADE GRANTING FINANCIAL ASSISTANCE AND THE PATIENT/GUARANTOR HAS BEEN NOTIFIED, CMH WILL NO LONGER ATTEMPT TO COLLECT THE DISCOUNTED AMOUNT. IF, DURING THE COLLECTION PROCESS, IT IS DETERMINED THAT SOMEONE MAY QUALIFY FOR FINANCIAL ASSISTANCE, THE COLLECTION PROCESS STOPS AND THE FINANCIAL ASSISTANCE APPLICATION PROCESS BEGINS. COLLECTION IS HALTED UNTIL THE FINANCIAL ASSISTANCE APPLICATION IS REVIEWED AND QUALIFICATION IS DETERMINED. APPROVED FINANCIAL ASSISTANCE REQUESTS WILL BE WRITTEN OFF WITHIN TEN DAYS FROM THE DATE APPROVED. THE DECISION TO WRITE OFF THE ACCOUNT IS PERMANENT. |
| PART VI, LINE 2: | COMMUNITY MEMORIAL HOSPITAL CONDUCTED A FORMAL COMMUNITY NEEDS ANALYSIS DURING 2016. IN ADDITION TO CONDUCTING THE NEEDS ASSESSMENT EVERY THREE YEARS, ADMINISTRATION MEETS WITH PROVIDERS AND CLINIC MANAGERS MONTHLY AND WITH THE MEDICAL STAFF GROUP BI-MONTHLY. DURING THESE MEETINGS, TOPICS FROM PATIENT INTERACTIONS ARE DISCUSSED TO IDENTIFY ANY COMMUNITY HEALTH NEEDS. |
| PART VI, LINE 3: | INDIVIDUALS ARE MADE AWARE OF FINANCIAL ASSISTANCE THROUGH POSTING OF THE POLICY AND APPLICATION IN THE ER, CLINIC, AND ADMISSIONS OFFICE. STAFF IN THE ADMISSIONS OFFICE PROVIDE INFORMATION TO INDIVIDUALS WHO MAY QUALIFY FOR MEDICARE, MEDICAID, OR OTHER FINANCIAL ASSISTANCE. |
| PART VI, LINE 4: | COMMUNITY MEMORIAL HOSPITAL SERVES SEVERAL COMMUNITIES IN SOUTH CENTRAL SOUTH DAKOTA AND NORTH CENTRAL NEBRASKA. THE AREAS SERVED ARE PRIMARILY FARMING/RANCHING AND RETIREMENT COMMUNITIES. WE HAVE A VERY LOW PERCENTAGE OF UNINSURED RESIDENTS IN OUR AREA. WE ARE LOCATED IN A FEDERAL HEALTH PROFESSIONAL SHORTAGE AREA. 64% OF THE ORGANIZATION'S REVENUE WAS FROM SERVING THE MEDICARE POPULATION, 9% WAS FROM TITLE 19, 12% FROM COMMERCIAL INSURANCE, AND 15% FROM OTHER SOURCES. |
| PART VI, LINE 5: | THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN THE ORGANIZATION'S SERVICE AREA WHO ARE NEITHER EMPLOYEES NOR CONTRACTORS OF THE ORGANIZATION. FAMILY MEMBERS OF FIVE MEMBERS OF THE GOVERNING BODY ARE EMPLOYED BY THE ORGANIZATION DUE TO THE SMALL POPULATION OF THE COMMUNITY. THE ORGANIZATION EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN ITS COMMUNITY. SURPLUS FUNDS, IF ANY, ARE REINVESTED FOR FACILITY AND EQUIPMENT UPGRADES, AND IMPROVING TECHNICAL SKILLS OF EMPLOYEES. MOST IMPROVEMENTS IN THE FACILITY AND EQUIPMENT IN THE PAST FEW YEARS WERE PURCHASED USING DONATIONS BY COMMUNITY MEMBERS DUE TO LACK OF SURPLUS FUNDS.COMMUNITY MEMORIAL HOSPITAL PROVIDES THE FOLLOWING TYPES OF COMMUNITY EDUCATION:A HEALTH FAIR IS PROVIDED SEMI-ANNUALLY FOR THE COMMUNITY WITH MANY DIFFERENT ASPECTS OF HEALTH CARE REPRESENTED. BLOOD DRAWS, BLOOD PRESSURES, GLUCOSE TESTING, AND DIFFERENT SCREENING TESTS ARE JUST A FEW OF THE SERVICES OFFERED BY THE HEALTH FAIR. IN ADDITION, EDUCATION FOR ALL SCHOOL AGES IS PROVIDED DURING A WEEK OF ACTIVITIES AT THE HOSPITAL. ACTIVITIES INCLUDE: TOURS OF DIFFERENT DEPARTMENTS, HAND WASHING TECHNIQUES, POISON CONTROL EDUCATION, AND A TEDDY BEAR CLINIC WHICH ENTAILS A TRIP TO THE EMERGENCY DEPARTMENT WITH THE TEDDY BEAR BEING THE PATIENT AND STUDENT BEING THE PARENT DESCRIBING THE COMPLAINTS. COMMUNITY MEMORIAL HOSPITAL ALSO PROVIDES CPR TRAINING TO BOTH THE STAFF AND COMMUNITY MEMBERS. DISASTER PREPAREDNESS TRAINING IS PROVIDED TO THE LOCAL FIRE DEPARTMENT. ADVANCED CARDIAC LIFE SUPPORT (ACLS) CLASSES AND TRAUMA NURSE CURRICULUM COURSE (TNCC) IS PROVIDED TO STAFF AS WELL AS NURSES FROM SURROUNDING COMMUNITIES. COMMUNITY MEMORIAL HOSPITAL SPONSORS DIFFERENT ACTIVITIES IN THE COMMUNITY AS WELL AS PARTICIPATES IN COMMUNITY PROJECTS, INCLUDING SCHOOL YEAR BOOK, AFTER PROM PARTY, PARADES AND OTHER COMMUNITY EVENTS. A GREAT DEAL OF PRIDE IS TAKEN IN THE COMMUNITY WITH THE COMMUNITY GIVING AS MUCH TO THE HOSPITAL AS THE HOSPITAL GIVES BACK TO THE COMMUNITY. |
Schedule L IRS990ScheduleL
Bus Tr Involve Interested Prsn BusTrInvolveInterestedPrsnGrp (7 entries)
| Relationship DescriptionRelationshipDescriptionTxt | TransactionTransactionAmt | TransactionTransactionDesc | Sharing Of RevenuesSharingOfRevenuesInd |
|---|---|---|---|
| DEBRA LEIBEL | |||
| FAMILY MEMBER OF TOM GLOVER, BOARD CHAIRMAN | $118,809 | BASE WAGES | 0 |
| JOLENE VANMETRE | |||
| FAMILY MEMBER OF KAREN MARTIN, BOARD SECRETARY | $33,515 | BASE WAGES | 0 |
| KIM SHEPPERD | |||
| FAMILY MEMBER OF AJ STEFFEN, BOARD DIRECTOR | $36,020 | BASE WAGES | 0 |
| ANDREA STEFFEN | |||
| FAMILY MEMBER OF AJ STEFFEN, BOARD DIRECTOR | $38,102 | BASE WAGES | 0 |
| AMY JURACEK | |||
| FAMILY MEMBER OF KATE WITT, BOARD DIRECTOR | $115,353 | BASE WAGES | 0 |
| AMANDA STEFFEN | |||
| FAMILY MEMBER OF AJ STEFFEN, BOARD DIRECTOR | $23,323 | BASE WAGES | 0 |
| SHARON NEUHARTH | |||
| FAMILY MEMBER OF SUE CHYTKA, BOARD DIRECTOR | $18,258 | BASE WAGES | 0 |
Schedule M IRS990ScheduleM
Other Non Cash Contri Table OtherNonCashContriTableGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Non Cash Checkbox | Yes (X) | NonCashCheckboxInd |
| Desc | MEDICAL EQUIPMENT | Desc |
| Contribution | 1 | ContributionCnt |
| Noncash Contributions Rpt F990 | $297,100 | NoncashContributionsRptF990Amt |
| Method Of Determining Revenues | FAIR MARKET VALUE | MethodOfDeterminingRevenuesTxt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Form8283 Received | 0 | Form8283ReceivedCnt |
| Any Property That Must Be Held | 0 | AnyPropertyThatMustBeHeldInd |
| Review Process Unusual NC Gifts | 0 | ReviewProcessUnusualNCGiftsInd |
| Third Parties Used | 0 | ThirdPartiesUsedInd |
Schedule O IRS990ScheduleO
Supplemental Information Detail SupplementalInformationDetail (12 entries)
| Form And Line ReferenceFormAndLineReferenceDesc | ExplanationExplanationTxt |
|---|---|
| FORM 990, PART VI, SECTION A, LINE 1 | THE EXECUTIVE COMMITTEE SHALL INCLUDE FIVE MEMBERS ALL OF WHOM SHALL BE MEMBERS OF THE BOARD OF DIRECTORS, AND SHALL INCLUDE THE CHAIR, THE VICE CHAIR, SECRETARY, AND THE ADMINISTRATOR. THE EXECUTIVE COMMITTEE SHALL HAVE THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE CORPORATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE SHALL NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, THE BYLAWS OR THE POLICIES OR EXPRESSED WISHES OF THE BOARD. |
| FORM 990, PART VI, SECTION A, LINE 3 | COMMUNITY MEMORIAL HOSPITAL HAS ENTERED INTO A MANAGEMENT AGREEMENT WITH SANFORD HEALTH NETWORK TO PROVIDE MANAGEMENT SERVICES FOR THE FACILITY. THE CEO OF COMMUNITY MEMORIAL HOSPITAL IS AN EMPLOYEE OF SANFORD HEALTH NETWORK. COMPENSATION AND BENEFITS FOR MISTIE SACHTJEN WERE $103,462 AND $28,233 RESPECTIVELY. DUTIES OF THE CEO INCLUDE: SUPPORTING FACILITY OPERATIONS AND ADMINSTRATION, RECOMMENDING BUDGETS AND MANAGING RESOURCES ACCORDINGLY, AND OVERSEEING DESIGN AND DELIVERY OF QUALITY PROGRAMS, PRODUCTS, AND SERVICES. |
| FORM 990, PART VI, SECTION A, LINE 6 | COMMUNITY MEMORIAL HOSPITAL HAS ONE CLASS OF GENERAL MEMBERSHIP. THE GENERAL MEMBERSHIP INCLUDES ANY INDIVIDUAL, PARTNERSHIP, CORPORATION OR ASSOCIATION WHO HAS CONTRIBUTED TO THE COMMUNITY MEMORIAL HOSPITAL BUILDING FUND OR CLINIC FUND AND WHO RESIDES IN THE FOUR-COUNTY AREA OF GREGORY AND TRIPP COUNTIES OF SOUTH DAKOTA AND KEYA PAHA AND BOYD COUNTIES IN NEBRASKA. THESE MEMBERSHIPS SHALL BE FOR THE LIFE OF THE CONTRIBUTOR AND ARE NOT TRANSFERABLE. IN ADDITION, ANY PATIENT OF THE HOSPITAL WHO HAS PAID THE HOSPITAL BILL IN FULL UPON DISCHARGE OR SHORTLY THEREAFTER AND WHO RESIDES IN THE PREVIOUSLY MENTIONED FOUR-COUNTY AREA SHALL BE A MEMBER OF THIS CORPORATION FOR THREE YEARS FROM THE DATE OF SAID PAYMENT IN FULL. ALSO, ALL MEMBERS OF THE LADIES AUXILIARY TO THE COMMUNITY MEMORIAL HOSPITAL, INC., OF BURKE, SOUTH DAKOTA, SHALL BE MEMBERS WITH FULL VOTING RIGHTS. PRESENT EMPLOYEES SHALL NOT BE CONSIDERED ELIGIBLE TO SERVE ON THE BOARD OF DIRECTORS. |
| FORM 990, PART VI, SECTION A, LINE 7A | GOVERNING BOARD MEMBERS ARE ELECTED BY THE MEMBERSHIP. |
| FORM 990, PART VI, SECTION A, LINE 7B | APPROVAL BY THE MEMBERS OF THE ORGANIZATION IS REQUIRED TO: ESTABLISH MISSION STATEMENT APPROVE THE SALE OF REAL PROPERTY ELECT OR REMOVE THE BOARD OF DIRECTORS APPROVE AMENDMENTS TO THE ARTICLES OF INCORPORATION REVIEW THE ANNUAL REPORT AND FINANCIAL AUDIT ESTABLISH SERVICES TO MEET THE NEEDS OF THE COMMUNITY |
| FORM 990, PART VI, SECTION A, LINE 8B | THE EXECUTIVE COMMITTEE DID NOT MEET IN 2017. |
| FORM 990, PART VI, SECTION B, LINE 11B | THE CEO DOES A DETAILED REVIEW OF THE FORM 990. TWO BOARD MEMBERS ALSO PERFORM A DETAILED REVIEW OF THE 990. A COPY OF THE 990 IS DISTRIBUTED TO ALL BOARD MEMBERS PRIOR TO FILING OF THE FORM WITH THE IRS. |
| FORM 990, PART VI, SECTION B, LINE 12C | THE CONFLICT OF INTEREST DISCLOSURE IS REQUIRED TO BE COMPLETED BI-ANNUALLY AND RESPONSES ARE REVIEWED BY THE CEO. IF A CONFLICT IS DEEMED TO EXIST, THE MEMBER(S) INVOLVED IS REQUIRED TO ABSTAIN FROM DISCUSSION, DELIBERATION, AND VOTING ON THE MATTER CAUSING THE CONFLICT. |
| FORM 990, PART VI, SECTION B, LINE 15A | SANFORD HEALTH NETWORK REVIEWS AND DETERMINES THE CEO'S COMPENSATION ANNUALLY. COMPENSATION RANGES ARE DETERMINED USING STATE SALARY SURVEY RESULTS. THE PROCESS AND DECISION IS DOCUMENTED AND MAINTAINED INTERNALLY BY SANFORD'S VP OF ADMINISTRATION. THE BOARD OF DIRECTORS OF COMMUNITY MEMORIAL HOSPITAL, INC, APPROVES THE AMOUNT OF THE CEO'S COMPENSATION THROUGH THEIR ACCEPTANCE OF THE MANAGEMENT AGREEMENT. |
| FORM 990, PART VI, SECTION C, LINE 19 | FINANCIAL STATEMENTS ARE DISTRIBUTED AT THE ANNUAL MEMBERSHIP MEETING, AND OTHER ITEMS ARE PROVIDED UPON REQUEST. |
| FORM 990, PART VII: | MISTIE SACHTJEN (CEO) UNDER MANAGEMENT AGREEMENT WITH SANFORD HEALTH NETWORK ACTS AS BOTH THE TOP MANAGEMENT OFFICIAL AND THE TOP FINANCIAL OFFICIAL. |
| FORM 990, PART IX, LINE 11G | CONTRACTED SERVICES : PROGRAM SERVICE EXPENSES 817,330. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 817,330. PURCHASED SERVICES : PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 80,418. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 80,418. |